TRENDS IN HOSPITAL MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION IN SWITZERLAND, 1998 TO 2008 THE REGION MAKES THE DIFFERENCE: DISPARITIES IN MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION WITHIN SWITZERLAND

The aim of this master's thesis was to assess the ten- year trends and regional differences in management and outcome of acute myocardial infarction (AMI) within Switzerland. The thesis is composed of two articles. First, in the article "Trends in hospital management of acute myocardial infarction in Switzerland, 1998 to 2008" over 102,700 cases of AMI with corresponding management and revascularization procedures were assessed. The results showed a considerable increase in the numbers of hospital discharges for AMI, namely due to the increase of between- hospital transfers. Rates of intensive care unit admissions remained stable. All types of revascularization procedures showed an increase. In particular, overall stenting rates increased with drug-eluting stents partly replacing bare stents. Second, in the article "The region makes the difference: disparities in management of acute myocardial infarction within Switzerland" around 25,600 cases of AMI with corresponding management were assessed for the period of 2007-2008 and according to seven Swiss regions. As reported by our results, considerable regional differences in AMI management were stated within Switzerland. Although each region showed different trends regarding revascularization interventions, Leman and Ticino contrast significantly by presenting the minimum and maximum rates in almost all assessed parameters. As a consequence these two regions differ the most from the Swiss average. The impact of the changes in trends and the regional differences in AMI management on Swiss patient's outcome and economics remains to be assessed. Purpose: To assess ten-year trends in management and outcome of acute myocardial infarction (AMI) in Switzerland. Methods: Swiss hospital discharge database for the 1998 to 2008 period. AMI was defined as a primary discharge diagnosis code I21 according to the CIM-10 classification of the World Health Organization. Management and revascularization procedures were assessed. Results: Overall, 102,729 hospital discharges with a diagnosis of AMI were analyzed. The number of hospital discharges increased almost three-fold from 5530 in 1998 to 13,834 in 2008, namely due to a considerable increase in between-hospital transfers (1352 in 1998, 6494 in 2008). Relative to all hospital discharges, Intensive Care Unit admission rate was 38.0% in 1998 and remained stable (36.2%) in 2008 (p for trend=0.25). Percutaneous revascularization rates increased from 6.0% to 39.9% (p for trend<0.001). Non-drug-eluting stent use increased from 1.3% to 16.6% (p for trend<0.05). Drug eluting stents appeared in 2004 and increased to 23.5% of hospital discharges in 2008 (p for trend=0.07). Coronary artery bypass graft increased from 1.0% to 3.0% (p for trend<0.001). Circulatory assistance increased from 0.2% to 1.7% (p for trend<0.001). Thrombolysis showed no significant changes, from 0.5% to 1.9% (p for trend=0.64). Most of these trends were confirmed after multivariate adjustment. Conclusion: Between 1998 and 2008 the number of hospital discharges for AMI increased considerably in Switzerland, namely due to between-hospital transfers. Overall stenting rates increased, drug-eluting stents partly replacing bare stents. The impact of these changes on outcome and economics remains to be assessed.

Paper 4: EUROCAT statistical monitoring: identification and investigation of ten year trends of congenital anomalies in Europe.

BACKGROUND: As part of EUROCAT's surveillance of congenital anomalies in Europe, a statistical monitoring system has been developed to detect recent clusters or long-term (10 year) time trends. The purpose of this article is to describe the system for the identification and investigation of 10-year time trends, conceived as a "screening" tool ultimately leading to the identification of trends which may be due to changing teratogenic factors.METHODS: The EUROCAT database consists of all cases of congenital anomalies including livebirths, fetal deaths from 20 weeks gestational age, and terminations of pregnancy for fetal anomaly. Monitoring of 10-year trends is performed for each registry for each of 96 non-independent EUROCAT congenital anomaly subgroups, while Pan-Europe analysis combines data from all registries. The monitoring results are reviewed, prioritized according to a prioritization strategy, and communicated to registries for investigation. Twenty-one registries covering over 4 million births, from 1999 to 2008, were included in monitoring in 2010.CONCLUSIONS: Significant increasing trends were detected for abdominal wall anomalies, gastroschisis, hypospadias, Trisomy 18 and renal dysplasia in the Pan-Europe analysis while 68 increasing trends were identified in individual registries. A decreasing trend was detected in over one-third of anomaly subgroups in the Pan-Europe analysis, and 16.9% of individual registry tests. Registry preliminary investigations indicated that many trends are due to changes in data quality, ascertainment, screening, or diagnostic methods. Some trends are inevitably chance phenomena related to multiple testing, while others seem to represent real and continuing change needing further investigation and response by regional/national public health authorities.

Editorial: Language, frequency and bibliometric indexes

This editorial examines the actions undertaken in number 5 and announces two important changes for the numbers 6 and 7, namely frequency and languages. Furthermore, the use of some bibliometric indicators, such as impact factor and refusal rate, is critically analyzed.

Declining labor force attachment and downward trends in unemployment and participation

The US labor market witnessed two apparently unrelated secular movements in thelast 30 years: a decline in unemployment between the early 1980s and the early 2000s,and a decline in participation since the early 2000s. Using CPS micro data and a stock-flow accounting framework, we show that a substantial, and hitherto unnoticed, factorbehind both trends is a decline in the share of nonparticipants who are at the margin ofparticipation. A lower share of marginal nonparticipants implies a lower unemploymentrate, because marginal nonparticipants enter the labor force mostly through unemployment,while other nonparticipants enter the labor force mostly through employment.

Trends in indices of daily precipitation extremes in Catalonia (NE Spain), 1951-2003

The aim of this paper is to quantitatively characterize the climatology of daily precipitation indices in Catalonia (northeastern Iberian Peninsula) from 1951 to 2003. This work has been performed analyzing a subset of the ETCCDI (Expert Team on Climate Change Detection and Indices) precipitation indices calculated from a new interpolated dataset of daily precipitation, namely SPAIN02, regular at 0.2° horizontal resolution (around 20 km) and from two high-quality stations: the Ebro and Fabra observatories. Using a jack-knife technique, we have found that the sampling error of the SPAIN02 regional averaged is relatively low. The trend analysis has been implemented using a Circular Block Bootstrap procedure applicable to non-normal distributions and autocorrelated series. A running trend analysis has been applied to analyze the trend persistence. No general trends at a regional scale are observed, considering the annual or the seasonal regional averaged series of all the indices for all the time windows considered. Only the consecutive dry days index (CDD) at annual scale shows a locally coherent spatial trend pattern; around 30% of the Catalonia area has experienced an increase of around 2¿3 days decade¿1. The Ebro and Fabra observatories show a similar CDD trend, mainly due to the summer contribution. Besides this, a significant decrease in total precipitation (around ¿10 mm decade¿1) and in the index "highest precipitation amount in five-day period" (RX5DAY, around ¿5 mm decade¿1), have been found in summer for the Ebro observatory.

Aplicacions del CD-ROM al mercat editorial: experiències i perspectives a Europa

Atesa la importància que darrerament estan adquirint els suports òptics, presentem una descripció de les aplicacions editorials del CDROM existents actualment a Europa, tot fent especial esment al projecte ADONIS. A més, pretenem fer una avaluació de les possibilitats i perspectives d'aquest nou suport d'informació.

Measures of health and disease in Africa: are current methods giving us useful information about trends in cardiovascular diseases?

An enormous burst of interest in the public health burden from chronic disease in Africa has emerged as a consequence of efforts to estimate global population health. Detailed estimates are now published for Africa as a whole and each country on the continent. These data have formed the basis for warnings about sharp increases in cardiovascular disease (CVD) in the coming decades. In this essay we briefly examine the trajectory of social development on the continent and its consequences for the epidemiology of CVD and potential control strategies. Since full vital registration has only been implemented in segments of South Africa and the island nations of Seychelles and Mauritius - formally part of WHO-AFRO - mortality data are extremely limited. Numerous sample surveys have been conducted but they often lack standardization or objective measures of health status. Trend data are even less informative. However, using the best quality data available, age-standardized trends in CVD are downward, and in the case of stroke, sharply so. While acknowledging that the extremely limited available data cannot be used as the basis for inference to the continent, we raise the concern that general estimates based on imputation to fill in the missing mortality tables may be even more misleading. No immediate remedies to this problem can be identified, however bilateral collaborative efforts to strength local educational institutions and governmental agencies rank as the highest priority for near term development.

La industria editorial frente al libro electrónico

El libro, la lectura y la industria editorial están experimentando cambios motivados por el progreso tecnológico. Los contenidos se han desvinculado del soporte y, en consecuencia, la industria editorial ha necesitado transformar su estructura logística, basada hasta hace poco en la distribución física. La impresión digital y las librerías virtuales cubren nuevas necesidades: han aumentado las posibilidades de visibilidad y de difusión de la producción editorial, y han eliminado barreras geográficas y físicas.

Trends in food availability in Switzerland, 1961-2007.

Trends in food availability in Switzerland were assessed using the Food and Agricultural Organization food balance sheets for the period 1961-2007. A relatively stable trend in the daily caloric supply was found: 3545 kcal/day in 1961 and 3465 kcal/day in 2007. Calories associated with carbohydrates decreased (slope±s.e.: -1.1±0.2 kcal/day/year), namely regarding cereals (-2.9±0.6 kcal/day/year) and fruit (-1.5±0.1 kcal/day/year), while the availability of sugars increased (1.2±0.5 kcal/day/year). In 1961, protein, fat, carbohydrates and alcohol represented 10.6, 33.5, 50.0 and 5.9% of total caloric supply, respectively; in 2007, the values were 10.8, 40.3, 43.7 and 5.2%. In 1961, palm, groundnut and sunflowerseed oil represented 3.4, 30.7 and 5.3% of total vegetable oils, respectively; in 2007, the values were 10.4, 3.7 and 31.6%. We conclude that between 1961 and 2007 total caloric availability remained relatively stable in Switzerland; the health effects of the increased and differing fat availability should be evaluated.